Endothelial dysfunction is associated with graft loss in renal transplant recipients

Endothelial dysfunction is prevalent in renal transplant recipients, but it is uncertain if there is an association with graft loss or mortality.

Since 1997, we have measured endothelial function noninvasively by forearm laser Doppler flowmetry in several small trials. These tests were pooled for the current analysis. We used Cox proportional hazard models to adjust for patient and graft characteristics. Due to significant heterogeneity between tests conducted before or after day 90 after transplantation, these were examined separately.

In the 175 patients examined after day 90 after transplantation, an endothelial function score below the median predicted graft loss (hazard ratio [HR], 1.85 [1.09-3.16]; P=0.02) and death-censored graft loss (HR, 2.63 [1.18-5.84]; P=0.02) but not all-cause mortality (HR, 1.20 [0.62-2.30]; P=0.58). In 140 patients examined before day 90 after transplantation, no association was found.

Endothelial dysfunction identified more than 90 days after transplantation was associated with renal graft loss.